An analogy for biomarkers in medical anthropology research?
Should anthropologists include biological measures in our research? Does it make our work somehow more legitimate or scientific when we do? Does including biology necessarily distract us from talking about complex social, historical, and cultural processes?
In considering these questions, I began thinking about pulse diagnosis in Chinese medicine (CM), the field I was trained in before embarking on my career as an anthropologist. If you are not familiar with CM pulse diagnosis, it is a subtle art where the practitioner feels the quality of a patient’s pulse at multiple points simultaneously at each wrist, one wrist at a time. What, we ask, does this pulse feel like against my fingers? I’ve written from an anthropological perspective about what it is like for students to learn this practice, how they come to link the CM terminology for different pulses with their embodied experience. The answer is far from straightforward.
The reason it is so important to get pulse-taking right is because the quality of a patient’s pulse offers a sense of what is happening in the landscape of their body. Pulse diagnosis, explains Shigehisa Kuriyama in his eloquent book, taps into suffering bodies as “sites of temporal disjunction.” Such bodies, in other words, are out of step with a certain flow that we call “health.” The overt symptoms are only the tip of the iceberg: the “branch.” Even for the simplest of symptoms, in CM the whole body requires attention in order to treat the “root” of illness. Pulse diagnosis is just one tool to “get a reading” on the inside of a patient’s body. It is far from the only thing that matters (though there are legends about physicians who could accurately prescribe an herbal formula on the pulse alone). For most of us, we need to take the pulse into consideration with a whole host of other readings, including inspection, listening, and inquiring. First visits to a CM practitioner are often long, taking over an hour—especially in the West, where the practice of CM is informed by person-centered medicine. A CM practitioner then pieces all of the information together in order to make a decision about how to treat: which formulas to prescribe, and which acupuncture points to needle. This must constantly be re-evaluated, moreover, from week to week as the patient lives her life.
I have mused about what it would be like to include pulse diagnosis in my ethnographic research. What happened to this individual’s pulse, for example, after that intense encounter or during this particular ritual ceremony? Does this privilege the biological even if it isn’t biomedicine? And how would I integrate this information into my analysis?
While they may not be using CM pulse diagnosis, there are many medical and psychological anthropologists who do draw upon various biological readings in their research. They use devices that can measure specific physiologic processes, like electrodermal activity or heart-rate variability, or they collect saliva samples in order to read cortisol or alpha-amylase levels. They look at DNA methylation or gene expression and then—like CM doctors (as well as many biomedical physicians who devote the time and attention to piecing together more than just the numbers, e.g., by listening to patient narratives)—they take that information and place it alongside ethnographic data collected through observation, interviews, and other anthropological techniques (look for upcoming work by Scarlett Eisenhauer, which also incorporates video). From this position, it becomes possible to understand, for example, how race becomes biology over time as sociocultural categories of race affect the bodies of individuals dealing with constant stress. Or it helps researchers untangle how cultural expectations with regards to gender and behavior, for example, relate to the way physical and mental illnesses interrelate and express among various populations.
Although I was never trained in any of these methods, I have begun—with my colleagues Jason DeCaro and Josh Pederson—to integrate some of these measurements into ethnographic research on emotion communication among spouses at home. It is research largely inspired by the CELF study at UCLA, which included (among other things) the use of naturalistic observation and cortisol analysis to study the ways in which couples coregulate their emotions on a day-to-day basis. It also ties in with work being done by Mendoza-Denton and colleagues to integrate psychophysiology with linguistic anthropology. The data we have collected so far is fascinating, and it is incredibly stimulating to be working with such genuinely mixed methods.
This column is not about our study, however. Nor is it a conversion story. As someone trained in an anthropological lineage that is highly resistant to the reductionist implications of biomarker measurement, I am far from convinced that fancy new devices or even CM pulse diagnoses provide “the answer” that anthropology has been searching for. I do, however, agree with Andreas Roepstorff that “the biological body” has been neglected in many anthropological studies—a point he made clear during his plenary presentation at the 2017 Society for Psychological Anthropology Meetings.
It was during this talk that I began thinking about the CM pulse as a possible analogy for the inclusion of biomarkers in anthropological research. The CM pulse provides an insightful “biomarker” (though arguably more “subjective” than cortisol or EDA). It does not, however, determine the diagnosis, which requires the practitioner’s in-depth interpretation of the pulse in context. If we think of biomarkers in a similar way—as part of a whole, complex picture that we must integrate with our own anthropological version of the clinical interview, as well as our observations, thick ethnographies, and in-depth historical analyses—then what biomarkers offer is insight into yet another dimension of the complex whole that we are seeking to analyze. “Privileging the biological substrate” is not, from this vantage point, a necessary outcome of using physiological measures in research. It may be a risk, especially given the current climate at many federal institutes and within mainstream medical publications, where the inclusion of biomarkers seems to index a more reliable scientific inquiry (and therefore a “real answer”). But if we, as anthropologists, learn to consider it like pulse-taking in CM—as one part of a whole that we are seeking to understand (and “treat” in our writing?)—perhaps it is possible to do without being “reductionist.”
Sonya Pritzker is a linguistic and medical anthropologist in the Department of Anthropology at the University of Alabama. Pritzker is also a licensed practitioner of Chinese medicine and has published extensively on the translation of Chinese medicine and the development of Chinese medicine in the US and China.
Cite as: Pritzker, Sonya. 2017. “Chinese Medical Pulse Diagnosis.” Anthropology News website, December 11, 2017. doi: 10.1111/AN.718